The PI of this application is David Tirschwell, MD, MSc, a board certified neurologist and Assistant Professor of Neurology at the Univ. of Washington in the physician-scientist tract. He is in the final year of a K23 award entitled, "The Medic One Stroke Scale". This study has enrolled 1,572 patients with a prehospital diagnosis of stroke. The results of the MOSS study are being used by the Seattle Fire Department to implement changes in the prehospital triage and evaluation of stroke patients. Medical records have been reviewed, requiring the cooperation of the local IRBs and physician colleagues from 10 Seattle area acute hospitals. Dr. Tirschwell has also conducted research on predictors of stroke outcome in Washington State using administrative databases. The K02 will allow Dr. Tirschwell to expand his research expertise into the area of quality of care (QOC) research and improvement with a focus on the care of ischemic stroke. This shin will be fostered by formal didactic training in advanced health services methods, a QOC advisory committee, formal training in quality improvement methods and practical experience in quality improvement for ischemic stroke by directing such efforts for the Stroke Center at Harborview Medical Center. The overall hypothesis to be tested in this K02 application is that QOC for patients with acute ischemic stroke can be effectively and inexpensively assessed with a balance of data collected from the medical record and administrative data sources. This hypothesis will be tested in a population of diverse race-ethnicity and socioeconomic status. The specific aims are: 1) Validate the use of administrative data and medical record data in quality of care research for acute ischemic stroke; 2) Identify a set of measures of quality of care for acute ischemic stroke; 3) Create an optimized patient dataset; 4) Organize a population-based consortium of hospitals from King County, WA, and perform a pilot study of quality of care for acute ischemic stroke. The results generated from the first 2 years of this project will serve as preliminary data for an R01 application that will determine systems to improve QOC for ischemic stroke in Washington State.